Attachment to Your Therapist III: How Relationships Transform

In a comment to the last post, M. asks whether she should be understanding of her therapist’s need to put his children first or focus more on her feeling of being neglected. Let’s get out our magnifying glass and look at just how feelings about your therapist can lead to positive change.

“1” = Cusp

The part I haven’t really focused on in previous posts is exactly how the relationship leads to healing. Usually after an initial “honeymoon” period, as you both settle into the work, the therapeutic relationship begins to bring up feelings. As time goes on, they hopefully get stronger and more explicit. Eventually, you get to the point where M. is. You are invested and involved enough to have real feelings, such as M’s of upset when her therapist takes care of his children’s needs ahead of hers.

Why the gothic image? In therapy, as in life, healing and growth happen at the cusp of two feelings. The original use of the word was to describe those points in gothic tracery where one curve meets a different one. It is where your tracing finger must abruptly change direction. The simplest and best studied example in therapy is trauma, where the therapeutic situation is set up to help you get in touch with painful feelings associated with trauma. What is special is that this time, the painful feelings intersect with comfortable and safe feelings associated with the therapist and the therapeutic situation. At that point or “cusp” when both feelings are active and intense, an amazing transformation takes place. I call this transformation “catharsis” because that’s what Freud called it and, to my knowledge, he was the first to describe it in any scientific way.

Current scientific thinking is that, at such moments, each of the two feelings is represented by a neural network, that is, a number of interconnected nerve cells that tend to be activated as a group and represent a certain mental content. In this case the content consists of feelings associated with memories or facts. Conscious awareness tells us that, simultaneously, two neural networks are strongly activated, one for the painful feelings and one for safety and empathic connection with the therapist. Science tells us that when two neural networks that were previously not associated are both activated at the same time, they become associated or “wired” together. This process takes only a few seconds to initiate, though it may take some hours (and perhaps sleep) to become permanent.

Can the same process of catharsis take place at other cusps of feeling? Of course. Let’s go back to the complex moment when M’s mixed feelings might intersect. Her therapist calls to say she is canceling a session because of a family emergency. I am guessing that M. feels sudden pang of disappointment, hurt and anger. At the same time, she feels concern for her therapist. Is she OK? Has something terrible happened to her child? Will the child be OK? Will she be available to help me? Unfortunately, this is not a therapeutic moment. Again, according to my guesses, two things take away the possibility of transformation. First, there is no time or place for M. to linger with her feelings, even for the few seconds that catharsis takes. It it time to make the best of the situation and move on. Second, M’s conscience comes in to spoil the opportunity. Her conscience says she should “be a good person” and suppress her selfish feelings when someone she cares about is in need. Quite automatically, M. shuts down her feelings and copes with her disappointment.

At their next session, let’s say M’s conscience has relented enough for her to feel her feelings all over again. She is feeling intensely hurt and angry at the same time that she is feeling empathy for her therapist. Suddenly one of them realizes that this mix of feelings is not new. The many times her parents had to attend to her sick sibling while she was neglected (for example) come to consciousness. Now the intensity of the hurt and anger are there for a reason. It is not that she is selfish and immature in wanting her therapist all to herself. Rather, the therapy has brought to the surface some important unfinished business from her past, the inevitable result of her sibling’s illness.

Let’s focus on the anger. M. feels anger towards her therapist at first. But it doesn’t really fit, because the therapist really did no wrong. This is what we call “displaced” feeling. It is the right feeling directed towards the wrong person. At least the feeling is active, but without the original context, it can’t heal. Then, with the realization that she has felt this before, M. is able to connect the feeling with the right context. The therapist now provides a safe context in which to feel the anger of a child who has legitimate needs independent of the sibling’s illness. In this new context, the feeling can heal in the same way traumatic memories do. The neural network of anger at parents gets “wired together” with the one representing that it is safe and OK and understandable to feel such things, even when a sibling is sick.
The same goes for the feelings of pain and loneliness when the therapist disappoints. That pain heals by catharsis just like the pain from trauma.

This is how the therapeutic relationship heals. At first the feeling is towards the therapist, and may be uncomfortable and threatening. As the therapist encourages exploration of what is happening, the feeling heals a little and becomes more safe. With safety, the mind is able to furnish the original context involving the parents and sibling. By that time, the therapist is able to serve as a comforting and empathic witness. Those are the conditions for catharsis: Feelings with their original details in a safe and empathic context.

There are still a few important points to clarify. First, there is some misconception in therapist circles that just having a healthy relationship with your therapist constitutes a “corrective emotional experience” and will heal you. Having a nice therapist who doesn’t have children or conflicting needs is not enough for healing and growth to take place. The reason is that “niceness” tends to reinforce our suppression of shameful, immature or problematic feelings. When feelings are suppressed, catharsis can’t take place. The troublesome moments in therapy, whether they involve feelings about the therapist or not, are the ones that can bring us to a cusp with important issues.

Second, let’s not mix up intellectual clarity with empathic understanding. “Mindfulness” doesn’t mean gaining an intellectual perspective. It refers more to an emotional sense of being understood and accepted. It is true that the therapist often has some wisdom about the situation and can share that with us, but the thing that makes for catharsis is the fact that the therapist is in tune with our intense feelings but not overwhelmed by them. It is the therapist’s empathy that activates neural networks representing safety. Intellectual understanding alone doesn’t necessarily mean empathy. Furthermore, “intellectualization” can and often does facilitate suppression of feeling, which, as stated above, means catharsis can’t take place.

Finally, what about feelings that come up when the therapist actually does something wrong. Therapists can make mistakes and do have counter-transferences. They can be caught unaware of their own emotions and can say or do things that are not in the patient’s best interest. If the error is not so grave as to end the therapy, then there is still work to do for both therapist and patient. This is the same as in other relationships where hurt is done. Forgiveness requires that the therapist address the event in some satisfactory way, as well as understanding the hurt done to the patient. Forgiving, too, involves the process of catharsis, whether we are forgiving a therapist or anyone else. Once again, there is a cusp between the feelings of hurt and anger that have been aroused by the error and feeling the therapist’s empathy with our hurt.

Now the complicated part. Much of the time, when the above scenario takes place, it also arouses feelings associated with unfinished business from the past. Just because the therapist has participated in creating the problem doesn’t mean the feelings all stem from the present. It is likely that there are also feelings from the past “piggybacked” on top of the present ones. How can you tell? When the feelings are out of proportion to what has happened in the present, it usually means that something from the past was activated as well. Unfortunately, in situations like this when the therapist’s role is not “clean” it is much more difficult to sort out which feelings come from where. The rule is this: Therapist and patient will first have to sort through and heal the present issue between them before clarifying what comes from the past. Only then, when present feelings are no longer so intense, is there a chance to identify and address what comes from the past. If clarity is not possible because of the murkiness of the situation, dealing with feelings from the past may have to wait till they are activated again under circumstances that are less confused.

Look at the SPSE (Scarsdale Psychotherapy Self-Evaluation) on this website. It will help you evaluate your therapist’s effectiveness in helping you. The cleaner your therapist’s work, the easier it will be to experience those feelings that belong to you on a cusp with safe and empathic feelings associated with the therapy. Then catharsis will happen and you will progress.

11 Comments

Thanks for these posts on attachment to one’s therapist and how the therapeutic relationship can heal. I’ve been in therapy now for about two and a half years, and I’ve suffered through major emotional storms during that time. So many intense feelings have come to the fore, and the whole process has been confusing and embarrassing to me. And I have an unbelievably difficult time letting my feelings — especially the ones related to my therapist — show during sessions (and here I’m talking about shame-inducing feelings such as jealousy, anger, possessiveness, longing, etc.). I think that, through talking to him, and because of reading many books (and benefiting from a few sites like this!), I’ve been able to feel my feelings toward him, journal about them, then understand where they originated, and do a lot of healing that way. But I wish I could let myself feel more, without closing up protectively, when I’m actually in the room. I tend to start analyzing/intellectualizing rather than feeling what I’m feeling. It’s hard for me to really trust him, even after all this time.

Anyway, I wanted to say thank you so much for freely sharing the info that you do on this blog. It has been a huge help to me in understanding my therapy and staying the course when I’ve been tempted to bail out. It is so difficult and confusing to have intense feelings toward someone you don’t really know! I think that has been the hardest thing about therapy.

Dear K, By “clean,” I mean that the therapist has not done anything but fulfill his or her role as facilitator of your process of growth. The last section of the SPSE, on safety gives more detail about therapist errors. In brief, these are the kinds of things described in the previous paragraph, where therapist needs or issues intrude on the therapy. If there is doubt, hopefully your therapist will engage in a genuine examination of what happened and will openly acknowledge his or her contribution to the difficulty. If you are still in doubt, it helps to share with a third party whom you trust to get a more objective take on what happened.

My therapist says that I often “act out” my frustrations, indicating that it is unacceptable behavior in the therapy room. When he says this I feel scolded and cannot ask him what he means by it and I cannot work through it because I am afraid of the answer he will give and I fear my inner critic shredding me to bits.

He also says that I am not trustworthy because I try to manipulate him, which I am sure is true but I do not know specifically what actions he considers manipulative (I am sure most of those actions are unconcious habits that make him uncomfortable) and I am afraid to ask him because I am afraid I will not want to hear what he has to say.

I do project my father onto him. My father was/is very harsh and is greatly disappointed in me as a daughter and person and takes every opportunity to let me know this. It makes for a very dificult therapy relationship since my therapist does not like this projection as it is not “clean” (I am bothered by that term as well…being female it brings up things that men may not understand)

I want to heal and I know I need to be brave and willng to hear painful/unflattering things about myself. I am interested in any guidance you might have to help me learn how to use these difficult situations to grow up rather than cower in fear or hurt others with my anger.

All therapists have conflicting needs, unless they are superhuman hermits. There’s always the possibility of a family emergency or serious illness or whatever. It’s early days for me in therapy and I have no idea how I would react to a cancelled session. Badly, I suspect. I would probably write down how I felt at the time before I suppressed it. I’ve done this before – emailed my feelings to my therapist before I talk myself out of having them, or bringing them.

I wondered if you had considered writing a post about having fantasies about your therapist. Not erotic transference, but more mundane ones. I read something online where someone said they fantasised about having to introduce their former and current therapist in the street. Personally I seem to have this odd wish to pass by my therapist while shopping in the supermarket with my husband (maybe an unconscious wish for him to see I don’t always act like the angry inner teenager I bring to his office and do actually function effectively in an adult relationship). Is this sort of thing common? And should I tell my therapist about it?

Thank you so much for your wonderful article. It helped me so much. I terminated from my therapist of 10 years in a very gentle way – going through the termination process. I had to heal so much trauma from my childhood. in those ten years. I loved my therapist. Her work with me was “clean”. Before I made the decision to leave, I discussed it with my therapist stating that I was feeling very much healed and able to handle my own issues.

I thought that I would feel a little bit sad and go on to enjoy my life. However, I wasn’t prepared for the intense feelings of grief and loss. It feels like my whole world is topsy turvy. What I am deducing from your article is that a great deal of healing and acceptance is taking place inside me in that I am grieving the loss of my therapist but also the realization that my unfulfilled dreams of parental love and caring will never be materialized, and that hopefully through the warmth and caring that I received from my therapist that the neurons will fire together and stay together. If possible could you reply to my message.

To give you some context of my question: I’ve been in psychoanalysis for almost 3 yrs, usually only 1 time per week (for financial reasons). About a month ago, I uncovered some old memories of painful childhood experiences of which I’d never spoken–or even thought about myself, really. This one particular childhood trauma was part of a host of other “secrets” that I suddenly realized I was not broaching in therapy. There was an overwhelming sense of, “OMG there is so much left to talk about, it is too painful, where do I even begin? HOW can I even begin?”

At any rate, I shared this one thing, which, in comparison, felt easier to discuss that any of the other things on my “list’ of secrets.

After the two sessions in which we discussed that topic, it occurred to me that in sharing this information, I had such a positive experience (“empathic witness”) that it was as if a huge burden had already been lifted from my heart and mind (and body). I felt an immense connection to my (wonderful) therapist which left me with an overall sense of being, at last, “protected.”

But my question about catharsis as a result of all of this, is related to my having since then also felt some general, over-arching relief/release, even in relation to those things that are still on the list of “secrets” (topics not yet broached) in my therapy work. Not only do I feel that, by having shared the one painful trauma with my therapist and in turn experiencing catharsis, I also now am realizing that I feel as if I have experienced this catharsis about the other secret topics, as well–without disclosing them. And it is hard for me to imagine that what I am experiencing is simply another means of avoidance/keeping secrets; it feels so much more real than that, as if by an experience of a truly beautiful healing on the one topic, that this has also freed me from the other topics, which perhaps I do not have to force myself to share.

Is there such a thing, do you believe, in a sort of comprehensive catharsis, even when some things remain unspoken? Could that one experience have healed me to such an extent that I feel protected and free in so many other, still undisclosed areas? Or do you think that a patient must always disclose every single thing that has impacted her/him, even when it feels unnecessary anymore to do so?

I should also note that, my therapist has suggested that she feels we have only “just barely touched upon” the topic of the first disclosed secret, while I, perhaps childishly, had hoped that perhaps we were “now done” with the topic as a whole, simply because I shared it. And because we have since that session had to, by necessity, address some other very immediate issues, we have, in fact, not (yet) again broached the topic of “Secret Number 1” (!); so I am assuming that soon, she will want to take up that topic again for further exploration. I am open to that; I just am not sure about the “other remaining secrets” being necessary to discuss. What if, now, I am not actually thinking of them so much as “secrets,” but more as “experiences in my past” which I may choose not to share?

I would love to hear your thoughts on all of this. One other note: I am working with a highly competent and experienced analyst, so I know she will be wise in her responses to my (possibly escapist) ideas on all of this once I get back in session. (I’m currently on a 2 wk vacation)

Terrific article. You have a unique talent for explaining complicated processes in a way that someone who hasn’t studied in the area but has been through therapy can understand. Your explanations are like a light bulb going off. Have you written any books on the subject of therapy?

the article was very helpful i am a 15 year old who is in therapy and i have a therapist i am very attached to i have been meeting with her for over a year now and she has been with me through thick and thin i am about to leave her and i need to express that I’m attached so hopefully i will be able to keep in contact any advice? (i leave in december by the end of the month so please respond fast)

Dear Jacob, My advice for everyone is to talk to your therapist about your feelings and attachment. Talk to her about your wish not to lose contact. If she has done a good job with you so far, she should be able to do a good job of helping you with this issue. It sounds like she is an important part of your growing and her influence will last far into the future. I should note that some therapists feel that leaving the door open could allow some issues around separation (theoretically) to remain covered up. To me it seems more natural to recognize that the real connection that has felt so helpful to you is permanent in both of you. As I have said in other places in this blog, the relationship with your therapist will always remain a therapy relationship. Often we have thoughts of turning it into a friendship, but that doesn’t usually work out. So good luck in the new year and the next phase of your life!

This is my first visit to this blog. And it is so what I need in my life right now. Thank you for this work and for guiding me to it. I understand most things intellectually. I even studied psychology years ago – getting my MS just to try to understand my own mental/ emotional struggles. I’ve been in therapy since I was 16. I’m 68 now. I found the ‘right’ therapist for me 23 years ago and have done incredible healing work with her around much childhood trauma. Therapy ended this past September. Suddenly and in an e- mail from my therapist. The story of the months prior to this happening is too complicated for me to put down here. And to be honest I don’t know what happened that she would not meet with me – talk things out – find out where the problem was coming from. My past. The present. Her life . All of the above. I KNOW I did nothing that crossed any ethical humanitarian boundary . I did not do anything TO her. As a nurse I know clients can be abusive to the very people who are trying to be helpful. Inappropriate behavior like making sexual advances; or using abusive language – even being physically aggressive. I guess I mention these extremes of behavior because for me those would be ( in my thinking) a reason for a therapist to send an email telling a client – ” don’t call”. “Don’t write”. ” Youre not being compliant”. My tendency is to always take the position of being ‘wrong’. I will and have come to the conclusion that if this happened. …. i must have deserved it. So even after 23 years of what I thought was the single best therapist I had ever tried to work with I still come to the conclusion that if something ‘bad’ happens in my life. … it must be my fault – I must have somehow done something Or said something that caused this thing to go so wrong. AND most importantly I deserve whatever punishment I get.